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Click a specific condition (below) to get a complete description of symptoms, treatments, etc.

[Dr. Lonstein] at Sarasota Spine Specialists and is the absolute best surgeon for anyone that has any spine problems anywhere. I have had problems most of my life and he has been a miracle for me. I would recommend him nationwide. Sincerely,

Penelope R.

March 2012

Herniated Disc Click for more info

The disc has a tough outer layer (annulus) surrounding a jelly-like substance in the center (nucleus). A herniation occurs when the nucleus breaks through the outer tissue layer. The discs are in front of the spinal cord and exiting nerves, and the herniated material may compress the nerves.

Full Description

Some of the terms commonly used to describe the condition include herniated disc, prolapsed disc, ruptured disc and the misleading expression "slipped disc". Other terms that are closely related include disc protrusion, bulging disc, pinched nerve, sciatica, disc disease, disc degeneration, degenerative disc disease, and black disc.
Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar disc herniation and cervical disc herniation. The former is the most common, causing lower back pain (lumbago) and often leg pain as well, in which case it is commonly referred to as sciatica.
Lumbar disc herniation occurs 15 times more often than cervical (neck) disc herniation, and it is one of the most common causes of lower back pain. The cervical discs are affected 8% of the time and the upper-to-mid-back (thoracic) discs only 1 - 2% of the time.

Causes

Disc herniations can occur from general wear and tear, such as jobs that require constant sitting, but especially jobs that require lifting. Traumatic (quick) injury to lumbar discs commonly occurs from lifting while bent at the waist, rather than lifting while using the legs with a straightened back. Minor back pain and chronic back tiredness is an indicator of general wear and tear that makes one susceptible to herniation on the occurrence of a traumatic event from bending to pick up a pencil, or heavy backpack from the floor. When the spine is straight, such as standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc can move from 17 psi (lying down) to over 300 psi (lifting with a rounded back).
Herniation of the contents of the disc into the spinal canal often occurs when the front side (stomach side) of the disc is compressed while sitting or bending forward, and the contents (nucleus pulposus) get pressed against the tightly stretched and thinned membrane (annulus fibrosis) on the rear (back side) of the disc. The combination of membrane thinning from stretching and increased internal pressure (200 to 300 psi) results in the rupture of the confining membrane. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, thus producing intense and usually disabling pain and other symptoms.

Treatment Options:

Thoracic Disc Herniation:

VATS – Video Assisted Thoracic Surgery

Discectomy

Fusion

Spinal Instrumentation

Lumbar Disc Herniation:

BAK Fusion Cages

ALIF (Anterior Lumbar Interbody Fusion)

PLIF (Posterior Lumbar Interbody Fusion)

TLIF (Transforamenal Lumbar Interbody Fusion)

IDET (Intradiscal Electrothermal Therapy)

Laminotomy

Laparoscopic Fusion

Artificial Disc Replacement

Cervical Disc Herniation

Microscopic Posterior Cervical Foraminotomy

Anterior Cervical Discectomy and Fusion

Cervical Laminaplasty

Cervical Instrumentation

General Disc Degeneration Click for more info

As we age, discs in the spine dehydrate. This is not always a painful condition. However, disc degeneration may follow injury to a disc. This condition may be more likely to be painful.

Full Description

Between each pair of bony vertebral bodies is a soft disc that acts as a shock absorber. The disc is made up of two parts, the annulus and the nucleus. The annulus is the outer part of the disc and is made of many rings of cartilage-like tissue. The nucleus, a jelly-like substance, is at the center of the disc. As we age, the disc can dehydrate, making it less supportive and more prone to injury. The disc height decreases as the disc dehydrates and can produce chemicals locally that irritate the surrounding tissue, causing neck or back pain. There may also be pain in the arms or legs. Disc degeneration is very common in the older population, but also occurs in younger adults. Factors contributing to disc degeneration are not fully understood, but there appears to be a genetic link. It is unclear how much activity “wear and tear,” such as with repetitive bending/lifting, truly affects disc degeneration.

Almost everyone’s discs dehydrate and degenerate with age. In many people, degeneration is not painful. Sometimes the process is painful. Acute disc pain may also occur after a tear or injury to the disc tissue.

Screening and Diagnosis

The diagnosis of painful disc degeneration begins with the doctor reviewing your history and performing a physical examination. X-rays may be made to investigate reduced disc height or other problems. An MRI scan may be obtained as it helps assess water content of the discs and any resultant “bulging” or protruding of the disc tissue. However, because disc degeneration is so common, many people have discs that look abnormal on an MRI, although they may not have back or neck pain. Because of this problem, other diagnostic tests, such as discography, may be done to verify if the disc is causing pain. Sometimes other injections are also done to rule out other possible pain origins.

Treatments for Degenerative Disc Disease

Typically, the first line of treatment includes active physical therapy and education. Strengthening of the muscles in the trunk and around the spine may help to reduce pain. Medication may be prescribed. If an unacceptable level of pain persists for several months after other treatments, surgical options may be considered. There are several minimally invasive procedures that are most frequently used for early stages of disc degeneration. Various interbody fusion procedures may be used in which disc tissue is removed and replaced with bone to stabilize the painful spinal segment. Total disc replacement or artificial discs may be used as well. The disc tissue is removed and a mobile disc prosthesis is put into the disc space. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.

Treatment Options:

Artificial Disc Replacement

BMP

Replacement of nucleus pulposus

Repair of annulus fibrosis

Gene Therapy

Spinal Stenosis Click for more info

The spinal canal is the passageway where the spinal cord and nerve roots reside. Spinal stenosis results when the canal is narrowed. The narrowing may result from disc protrusions or herniations, thickening of the ligaments within the canal, movement of the vertebral bodies or osteophytes (bone spurs) growing into the canal.

Full Description

The spinal canal is the passageway where the spinal cord and nerve roots reside. Spinal stenosis results when the canal is narrowed. The narrowing may result from disc protrusions or herniations, thickening of the ligaments within the canal, movement of the vertebral bodies or osteophytes (bone spurs) growing into the canal. Whether an individual will develop stenosis cannot be predicted. It does not have a predisposition for any sex, race or ethnicity. Spinal stenosis can be congenital, meaning present at birth. Acquired stenosis is more common and generally affects people 60 or more years of age. Spinal stenosis may affect the cervical or lumbar spine. Symptoms include nerve compression leading to persistent pain in the buttocks, limping, lack of feeling in the extremities, or loss of bladder or bowel control. Often, patients have difficulty walking even relatively short distances because of leg symptoms of pain or weakness. This typically resolves with a brief period of rest.

Screening and Diagnosis

Your physician will perform a physical examination. Imaging studies such as an MRI, CT scan or myelogram may also be ordered to help make the diagnosis. If the doctor thinks you have nerve damage, an electromyography (EMG) may be needed. This exam measures the effectiveness of your nerves to conduct signals.

Treatments for Spinal Stenosis

Non-surgical options include medication, physical therapy, aerobic conditioning and epidural injections. Indications for surgery include pain that fails to improve satisfactorily with non-surgical treatment. Surgical treatment generally consists of spinal decompression to enlarge the spinal canal and relieve the pressure on the spinal cord or nerve roots. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.

Treatment Options:

Foraminotomy

Surgical Decompression

Laminectomy

Laminotomy

Kyphosis Click for more info

Kyphosis is a forward rounding of your upper back. Some rounding is normal, but the term "kyphosis" usually refers to an exaggerated rounding, more than 40 to 45 degrees. This deformity is also called round back or hunchback.

Full Description

With kyphosis, your spine may look normal or you may develop a hump. Kyphosis can occur as a result of developmental problems; degenerative diseases, such as arthritis of the spine; osteoporosis with compression fractures of the vertebrae; or trauma to the spine. It can affect children, adolescents and adults.

Mild cases of kyphosis may cause few problems. But severe cases can affect your lungs, nerves and other tissues and organs, causing pain and other problems. Treatment for kyphosis depends on the cause of the curvature and its effects.

Causes

Your spine (vertebral column) is composed of bones (vertebrae), which are held together by tough, fibrous bands (ligaments). The vertebral column consists of seven neck (cervical) vertebrae, 12 middle back (thoracic) vertebrae and five lower back (lumbar) vertebrae. Lumbar vertebrae are the largest, and they carry most of your body's weight. The sacrum, containing five fused vertebrae, is below the lumbar vertebrae. The last three tiny vertebrae, also fused together, are called the tailbone (coccyx).

Kyphosis is a forward rounding of the vertebrae in your thoracic spine. The vertebrae in your thoracic spine connect to your ribs.

Causes of kyphosis depend on the different types of kyphosis.

Types of kyphosis in children and adolescents
For children or adolescents, the most common types include:

Postural kyphosis. This type mainly becomes apparent in adolescence. The onset of postural kyphosis generally is slow. It's more common in girls than in boys. Poor posture or slouching may cause stretching of the spinal ligaments and abnormal formation of the bones of the spine (vertebrae). Postural kyphosis often is accompanied by an exaggerated inward curve (hyperlordosis) in the lower (lumbar) spine. Hyperlordosis is the body's way of compensating for the exaggerated outward curve in the upper spine.

Scheuermann kyphosis. Like postural kyphosis, Scheuermann kyphosis typically appears in adolescence, often between ages 10 and 15, while the bones are still growing. Also called Scheuermann disease, it's about twice as common in boys as it is in girls. Scheuermann may deform the vertebrae so that they appear wedge shaped, rather than rectangular, on X-rays. There may be another finding, known as Schmorl nodes, on the affected vertebrae. These nodes are the result of the cushion (disk) between the vertebrae pushing through bone at the bottom and top of a vertebra (end plates).

The cause of Scheuermann kyphosis is unknown, but it tends to run in families. Some people with this type of kyphosis also have scoliosis, a spinal deformity that causes a side-to-side curve. Adults who developed Scheuermann during childhood may experience increased pain as they get older.

Congenital kyphosis. A malformation of the spinal column during fetal development causes kyphosis in some infants. Several vertebrae may be fused together or the bones may not form properly. This type of kyphosis may worsen as the child grows. After trauma and infection, congenital kyphosis is the next most common cause of paralysis of the lower body (paraplegia).

Causes in adults
Disorders that may cause a curvature of the spine in adults, resulting in kyphosis, include:

Osteoporosis, a bone-thinning disease that's associated with fractures of the vertebrae, which cause compression of the spine and contribute to kyphosis

Degenerative arthritis of the spine, which can cause deterioration of the bones and disks of the spine

Ankylosing spondylitis, an inflammatory arthritis that affects the spine and nearby joints

Connective tissue disorders, such as Marfan syndrome, that may affect the connective tissue's ability to hold joints in their proper position

Tuberculosis and other infections of the spine, which can result in destruction of joints

Cancer or benign tumors that impinge on bones of the spine and force them out of position

Spina bifida, a birth defect in which part of the spine doesn't form completely, and which causes defects of the spinal cord and vertebrae

Conditions that cause paralysis, such as cerebral palsy and polio, and that stiffen the bones of the spine

Treatment Options:

Fusion with Bone Graft

Fusion with Instrumentation

Spondylolisthesis Click for more info

Spondylolisthesis occurs when one vertebral body slides forward relative to the one below it. It can be congenital (present at birth) or develop in adolescence or adulthood. The disorder may result from the physical stresses to the spine from physical activity, trauma, and general wear and tear.

Full Description

Spondylolisthesis occurs when there is abnormal alignment of the spine when seen from the side (lateral view). The vertebra above slides forward relative to the one below it. This malalignment may result from several causes, including trauma or degeneration. There may be abnormal spinal motion associated with this condition. Spondylolisthesis may result in back or neck pain, but extremities can be involved if the spinal cord or nerve roots are compressed or irritated. Commonly, patients will complain of muscle spasms, thigh and/or buttock pain, as well as tight hamstrings. There are patients who have spondylolisthesis and do not have symptoms. Spondylolisthesis can be congenital (present at birth) or develop in adolescence or adulthood. The disorder may result from the physical stresses to the spine from physical activity, trauma, and general wear and tear.

Screening and Diagnosis

The best initial test for diagnosis of spondylolisthesis is an x-ray taken in the standing position. For further confirmation of spondylolisthesis, a CT scan may be ordered. If the slipped vertebra is suspected to be pressing on nerves, the doctor may order a myelogram. In addition to imaging studies, part of your visit to the doctor will include physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion and physical condition, noting any movement that causes you pain. During the neurological exam, your doctor will test your reflexes and muscle strength. Most commonly with spondylolisthesis, the neurological exam findings are relatively normal.

Treatments for Spondylolisthesis

Treatment varies with severity of the spondylolisthesis. Most patients require only physical therapy combined with activity modification. If pain is arising from nerve root irritation, epidural steroid injection may be considered. For cases with severe pain not responding to therapy, if the slip is severe or there are neurologic changes, the slipping vertebra might be surgically fused to the vertebra below it. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.

Treatment Options:

Anterior and Posterior Decompression with Fusion Cages

Laminectomy Decompression with Graft

Posterolateral Fusion

Spinal Instrumentation with Pedicle Screws

Spondylosis (Osteoarthritis) Click for more info

Spondylosis is typically a degenerative condition of spinal joints and is also known as spinal osteoarthritis. Discs, joints and ligaments are usually involved. Discs lose their cushioning effect, ligaments become weaker or thicken, and vertebrae can develop bony growths or spurs.

Full Description

Spondylosis is typically a degenerative condition of the joints of the spine and is also known as spinal osteoarthritis. The discs, joints and ligaments of the spine are generally involved. The discs lose their cushioning effect between the spinal bones, the ligaments become weaker or thicken, and the bones can develop bony growths or spurs. Aging and repetitive stresses to the spine are the primary causes of this degeneration, but it also can be present in younger adults who have had prior trauma. Not everyone will have symptoms (usually pain) as a result of spondylosis. If severe, spondylosis may cause pressure on nerve roots with subsequent pain or tingling in the arms or legs.

Screening and Diagnosis

Your doctor will first perform a physical exam to observe your posture, range of motion and physical condition, noting any movement that causes you pain. A neurological exam may also be performed to test your reflexes and muscle strength. This evaluation also checks out other symptoms, such as numbness, tingling, or bowel and/or bladder problems. As your doctor develops the diagnosis, imaging tests may be performed. These may include x-rays, CT or MRI. An MRI is especially good at showing abnormal discs, ligaments or nerve roots. CT scans can show inflammation of the facet joints, which could indicate spondylosis. With an x-ray, your doctor will be able to see the bony elements of your spine.

Treatments for Spondylosis

Non-surgical options include epidural injections, chiropractic care, pain management medications and physical therapy. If the pain continues or there is evidence of a severely compressed nerve, surgery may be considered. Surgery for spondylosis involves two main components: eliminate what is causing pain and then fusing the spine to control movement. Surgery may also include decompression, which is removing the tissue that is pressing on nerves. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.

Sprain / Strain Click for more info

An exact diagnosis may be difficult to assess since muscular strain, ligamentous sprain and mild disc herniation may all present with similar symptoms. Symptoms will include muscular tenderness and weakness.

Many factors can cause these symptoms but muscular or ligamentous injury are the usual culprits. Regardless of the cause, initial treatment will be the same. A brief period of rest (usually 24-48 hours) and anti-inflammatory medication will be beneficial for the patient. This treatment can then be followed with a gradual return to weight-bearing activities. Many physicians will order a course of physical therapy for the patient which may include "back school."
"Back school" is a regimented program of exercise designed to strengthen and stabilize the muscles and ligamentous structures of the spine. The program also stresses proper body biomechanics which includes how to properly perform activities of daily living. This would include increasing the flexibility of the spine to better perform activities from tooth brushing to gas pumping to vacuuming. These classes and/or a course of physical therapy are ordered for the patient in an effort to reduce recurrence of injury.
Lifestyle changes may be employed as well to decrease predisposition to chronic low back pain. Smoking, which decreases overall circulation in the body should be eliminated. Obesity, poor body mechanics and wearing high heeled shoes are also indicators for low back pain. Whenever the body's center of gravity is shifted forward, an added strain is placed upon the discs.

Spinal Fracture Click for more info

Many people mistake spinal fractures for backaches, which they assume are just part of getting older. The primary symptom of compression fractures is back pain that is made worse by movement. When the spinal cord is involved, numbness, tingling, weakness, bowel/bladder dysfunction or even paralysis may occur.

Full Description

Spine fractures can occur at any segment of the spinal column. The spinal column is made up of multiple vertebrae. Fractures can involve the vertebral body or the posterior elements of the spine. The posterior elements form the back wall of the spinal canal and provide protection for the spinal cord. Spinal fractures can happen from something as dramatic as a fall or motor vehicle accident, or, in a patient with osteoporosis, from a simple movement like coughing or reaching overhead. Osteoporosis, or loss in bone quality, makes the vertebrae vulnerable to vertebral compression fractures. The pain from an osteoporotic fracture is not always severe – sometimes it is mild. Many people mistake these spinal fractures for backaches, which they assume are just part of getting older. The primary symptom seen in compression fractures is moderate to severe back pain that is made worse by movement. When the spinal cord is involved, numbness, tingling, weakness, bowel/bladder dysfunction or even paralysis may occur.

Screening and Diagnosis

The first step in the evaluation of spinal fractures is to get a detailed history about what caused the injury. The doctor will perform a physical examination. This may include checking for swelling, bruising, tenderness and other signs of injury to the head, abdomen and back as well as evaluating strength, motion and alignment of arms and legs. A neurologic examination may also be done. This may include tests of sensory (temperature, pain and pressure sensitivity), motor (muscle strength) and reflex functions of the nervous system. In addition, x-rays may be necessary to look for fractures or dislocations. Often computed tomography (CT) or magnetic resonance imaging (MRI) scans may be ordered to determine the extent of injury.

Treatments for Spinal Fracture

Treatment goals include protecting nerve function and restoring alignment and strength of the spine. Treatment options are based upon the type of fracture and other factors. Non-surgical treatment options include wearing a brace for sitting and standing activities for 6 to 12 weeks. Patients should walk and do other exercises while healing and may take medications for pain. Depending on the symptoms and the type of fracture, surgery may be an option. For some fractures, metal screws and rods or plates may be used to realign the spine. For osteoporotic fractures, vertebroplasty or Kyphoplasty may be performed. These are minimally invasive procedures in which a bone cement is injected into the fractured vertebrae. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.